Factors Associated with Postoperative Urinary Retention in Patients Undergoing Penile Prosthesis Implantation

Introduction: Many implanters have transitioned penile implantation procedures from 23-hour observation (OBS) stays to same-day discharge surgeries (SDS). Postoperative urinary retention (POUR) represents a potential barrier to successful SDS among inflatable penile prosthesis (IPP) recipients; however, its incidence and resolution have not been well characterized. We rigorously characterized POUR in a cohort of IPP recipients along with risk factors and management. Materials: and Methods: Patients undergoing IPP from 2014 through 2020 without pre-existing retention were included. All patients underwent void trial immediately following IPP in PACU. POUR was strictly defined as: 1) any patient requiring catheter replacement after IPP, 2) a rising post-void residual (PVR), or 3) inability to void after 6 hours regardless of whether a catheter was placed. Independent demographic, intraoperative, and postoperative risk factors for POUR were assessed using multivariable logistic regression. Results: : 317 men were included of whom 27.1% experienced POUR. Rates of POUR in patients under OBS or SDS were not significantly different (29.2% vs. 18.0%, p=0.11). Men experiencing POUR and those not in retention were essentially indistinguishable with respect to risk factors for POUR. Only maximal medical therapy for BPH was significantly associated with a greater risk of POUR, a finding maintained on adjusted analysis (aOR 10.1, 95% CI 2.1 to 49.8). POUR resolved without intervention in 3.5%, a single episode of CIC in 7.0% of patients, and repeated CIC or indwelling catheter placement with a successful delayed void trial in 88.4% of patients. Rate of IPP infection in patients who experienced POUR vs. N-POUR did not differ (4.7% vs. 2.2% p=0.26). Conclusion: POUR is experienced in as many as 1 in 4 men undergoing IPP placement, most of whom must be managed with indwelling catheterization or repeated CIC. Those with indicators of symptomatic BPH are at significantly greater risk of urinary retention.